5′-NT及其与ALT联合检测在鉴别ALP升高的恶性肿瘤骨转移中的价值

The value of serum 5′-nucleotidase and its combination with alanine aminotransferase in identifying bone metastases in cancer patients with elevated ALP

目的研究血清5′核苷酸酶(5′-NT)及其与丙氨酸氨基转移酶(ALT)联合检测在鉴别血清碱性磷酸酶(ALP)升高的恶性肿瘤骨转移中的价值。方法选取2018年12月~2019年8月中国医学科学院北京协和医学院肿瘤医院就诊恶性肿瘤患者176例。其中血清ALP水平升高但无骨转移患者88例为ALP升高肝癌组;血清ALP水平升高但其余肝功能指标均正常的骨转移患者88例为ALP升高恶性肿瘤骨转移组;同期选取健康志愿者50名为正常对照组。测定三组血清5′-NT及ALT水平。结果 ALP升高肝癌组5′-NT阳性率高于ALP升高恶性肿瘤骨转移组(P <0.01),ALP升高肝癌组血清5′-NT水平高于ALP升高恶性肿瘤骨转移组及正常对照组(P <0.01)。血清5′-NT或ALT水平升高为ALP升高恶性肿瘤患者骨转移的保护因素。5′-NT判断ALP升高为恶性肿瘤骨转移的曲线下面积(AUC)为0.966,当临界值<5.6 U/L,灵敏度为90.91%,特异性为89.77%;5′-NT联合ALT检测时AUC为0.980,特异度可提高至96.49%。结论 5′-NT及ALT联合检测在鉴别ALP升高的恶性肿瘤骨转移中具有一定的临床价值。

Objective To explore the value of serum 5′-nucleotidase(5′-NT)and its combination with alanine aminotransferase(ALT)in identifying bone metastases in cancer patients with elevated alkaline phosphatase(ALP).Methods A total of 176 cancer patients who enrolled from Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from December 2018 to August 2019 were selected.Among them,88 cases with elevated ALP but without bone metastasis were named the liver cancer with elevated ALP group;other 88 cases with bone metastasis and elevated ALP but normal liver function were named the cancer with bone metastasis and elevated ALP group;50 healthy volunteers were named the normal control group at the same time.The levels of serum 5′-NT and ALT were detected in three groups.Results The positive rate of 5′-NT in the liver cancer with elevated ALP group was higher than that in the cancer with bone metastasis and elevated ALP group(P<0.01).The serum levels of 5′-NT in liver cancer with elevated ALP group were higher than those in the cancer with bone metastasis and elevated ALP group and the normal control group(P<0.01).The increased serum 5′-NT or ALT levels were protective factors for bone metastases in cancer patients with elevated ALP.The area under the curve(AUC)of 5′-NT to judge the elevation of ALP to malignant tumor bone metastasis was 0.966,and the sensitivity was 90.91%and the specificity was 89.77%when the critical value was<5.6 U/L.The AUC of 5′-NT combined with ALT was 0.980,and the specificity was increased to96.49%.Conclusion The combined detection of 5′-NT and ALT has a certain clinical value in differentiating bone metastases of malignant tumors with elevated ALP.